What is Quality? Definition of Quality in healthcare? Quality Evolution . Quality control. Quality Assurance. Total Quality Management. Old vs. TQM Approach. The Deming, Juran and Crosby philosophies. Quality Principles. Why Quality? Quality perspectives. Key Dimensions of Quality. Good Managers (Leaders)

1. Prepared by
Mouad Hourani RN,BSN,MPH.
Nursing Quality Supervisor
Oct.2014
Nursing Management and Leadership course Total Quality Management
Sultan Bin Abdul-Aziz Humanitarian City Nursing Services

2. Table of contents
1.What is Quality?
2.Definition of Quality in healthcare?
3.Quality Evolution .
4.Quality control.
5.Quality Assurance.
6.Total Quality Management.
7.Old vs. TQM Approach.
8.The Deming, Juran and Crosby philosophies.
9.Quality Principles.
10.Why Quality?
11.Quality perspectives.
12.Key Dimensions of Quality.
13.Good Managers (Leaders)

3. What is Quality?
Fitness to use
Excellence
Satisfaction
Standard are created when the experts are able to understand what the right things are and how the right things are best achieved.
QA,QC,TQM

4. Definitions of Quality in Health care
Quality as dictionary defined (Webster's new world college and American heritage dictionaries):
Having a high degree of excellence
Doing the right things right the first time

5. 1.Freedom from deficiencies :
freedom from any avoidable intervention required to achieve an equivalent outcome
Ex:Nosocomial infection, lost lab result etc.
2.Product features:
services attract and satisfy patients ,meet customer expectation and distinguish one organization from others
Ex: computerized health record, follow up care
Juran institute defines quality as

6. Accessible, effective, safe, accountable, and fair
This means:
Providers deliver the right care to the right patient at the right time in the right way.
Patients can access timely care, have accurate and understandable information about risks and benefits ,are protected from unsafe health care services and have reliable and understandable information on the care they receive.
Both patients and clinicians have their rights respected.
AHRQ and AHCPR Defines Quality:
AHRQ (the U.S Government Agency for Healthcare Research Quality)
AHCPR ( Agency for Healthcare Policy and Research)

7. Quality Evolution
Inspection
Quality Control
Quality Assurance
Total Quality
Management
Reactive Approach
Proactive Approach
Detection
Finding & Fixing mistakes
Prevention Stop defects at source. Zero defects
1
2
3
4
Inspect products
Incorporates QC/QA activities into a company-wide system aimed at satisfying the customer. (involves all organizational functions)
Planned and systematic actions to insure that products or services conform to company requirements
Operational techniques to make inspection more efficient & to reduce the costs of quality. (example: SPC)

8. Quality Control
The purpose of quality control is to uncover defects and have them corrected so that defect-free products will be produced.
Quality control is limited to looking at products .
Quality control is testing the final product against product quality standards.
Quality control is operational techniques that are used to fulfill requirements for product quality.
Juran says, software quality control is the process of measuring actual quality, comparing this to some standard, and then acting on the discrepancy.

9. Quality Assurance
Quality assurance is oriented toward preventing defects.
It is defined by those activities that modify the development processes to prevent the introduction of defects.
Quality assurance is more concerned with the processes that produce the final product, and making sure that quality is part of each phase.
QA is about maturing the process towards minimum defect.
It is about balancing methodology, leadership, and technology.
It is about taking into account human factors as well as technological ones.

10. Total Quality Management
Philosophy of TQM revolves around customer driven management.
Its major emphasis is on determining customer need or expectation from the product.
Total Quality is the culture of the organization.
It is attitude of people how they perform their assigned work with aims to provide, customers with products and services that satisfy their needs.
The culture change means all members of the organization participate in the improvement of process, products, and services.

11. TQM Philosophy
“Do the right things, right the first time, every time”
You must put a quality product into QC before you can expect to get out one, otherwise wastage (or rework) will be very high.

12. Total QM Philosophy
The concept of TQM as advocated by management theorists and industrial engineers has been adopted by healthcare leaders.
Definition of TQM: involving quality and leadership commitment which provide the energy and rationale for implementation of the process of CQI within the organization wide quality strategy.

13. Old vs. TQM Approach
Quality Element
Previous Approach
TQM Approach
Definition
Product-oriented
Customer-oriented
Priorities
2nd to service and cost
Equals of service and cost
Decisions
Short-term
Long-term
Emphasis
Detection
Prevention
Errors
Operations
System
Responsibility
Quality control
Everyone
Problem Solving
Managers
Teams
Procurement
Price
Life-cycle costs,partnership
Manager’s Role
Plan, assign, control, and enforce
Delegate, coach, facilitate and mentor

14. The Deming philosophy
14 points for management:
1.Create and publish to all employees a statement of the aims and purposes of the company. The management must demonstrate their commitment to this statement.
2.Learn the new philosophy.
3.Understand the purpose of inspection – to reduce the cost and improve the processes.
4.End the practice of awarding business on the basis of price tag alone.
5.Improve constantly and forever the system of production and service.

15. 6.Institute training
7.Teach and institute leadership.
8.Drive out fear. Create an environment of innovation.
9.Optimize the team efforts towards the aims and purposes of the company.
10.Eliminate exhortations for the workforce.
11.Eliminate numerical quotas for production.
12.Remove the barriers that rob pride of workmanship.
13.Encourage learning and self-improvement.
14.Take action to accomplish the transformation.
The Deming philosophy

16. The Juran philosophy
Quality Trilogy:
1.Quality planning: Process of preparing to meet quality goals. Involves understanding customer needs and developing product features.
2.Quality control: Process of meeting quality goals during operations. Control parameters. Measuring the deviation and taking action.
3.Quality improvement: Process for breaking through to unprecedented levels of performance. Identify areas of improvement and get the right people to bring about the change.

17. The Crosby philosophy
Absolute’s of Management
Quality means conformance to requirements not elegance.
There is no such thing as quality problem.
There is no such thing as economics of quality: it is always cheaper to do the job right the first time.
The only performance measurement is the cost of quality: the cost of non-conformance.
Basic Elements of Improvement
Determination (commitment by the top management)
Education (of the employees towards Zero Defects (ZD))
Implementation (of the organizational processes towards ZD)

18. Quality Management Principle:
Customers(internal and external):needs, expectations.
Employees/staff: expertise, recommendation, access to top management, involvement in planning and decision making.
Management: commitment, empowerment of employees.
Teamwork .
Focus on process and system rather than individual.

19. Focus on prevention rather than inspection
Use of formal problem solving methods and statistical tools
Quality Management Principle: Cont..

20. Why Quality?
Eliminate hazard to patient
Eliminate rework
Save time and money
 Desire for recognition and the strive for excellence
Pressure of competition and to enhance marketing
Requirement to define and meet patient needs and expectations
Accreditation ,certification

21. Quality perspectives
Everyone defines Quality based on their own perspective of it. Typical responses about the definition of quality would include:
1.Perfection
2.Consistency
3.Eliminating waste
4.Speed of delivery
5.Compliance with policies and procedures
6.Doing it right the first time
7.Delighting or pleasing customers
8.Total customer satisfaction and service

22. 1.Appropriateness:
The degree to which the care and services provided are relevant to the patients clinical needs.
Is the intervention correct? given the needs?
2.Availability:
Is there sufficient access to care?
Key Dimensions of Quality:

23. 3.Competency:
practitioners ability to produce customer satisfaction and adheres to standards of care
Are practitioners qualified to provide the care?
4.Continuity:
Are the care provided in continuous way?
5.Effectiveness :
Are positive outcomes are reached?

24. 6.Efficiency:
The relationship between outcome and the resources used to deliver patient care.
Are the treatment provided in manner that conserve resources?
7.Safety :
avoid the risks for patients and health care providers
8.Timeliness:
provide the health care at the most necessary time

25. Good Managers (Leaders)
1.Give priority attention to customers and their needs
2.Empower, rather than control, subordinates.
3.Emphasize improvement rather than maintenance.
4.They emphasize prevention.
5.Encourage collaboration rather than competition.
6.They train and coach, rather than direct and supervise.

26. 7.Learn from problems.
8.They continually try to improve communications.
9.They continually demonstrate their commitment to quality.
10.Choose suppliers on the basis of quality, not price.
11.Establish organizational systems to support the quality effort.
12.Encourage and recognize team effort.
Total Quality Management
Good Managers (Leaders)

27. Thank you